How Second Opinions Promote Good Therapy


Psychotherapy, even good therapy with a fine therapist can get stuck. Especially if the beginning was OK and there haven’t been major errors, as therapy progresses, old patterns begin to dominate. This actually should happen for you because that’s how you can come to understand the patterns and change them. Therapist’s, too have old patterns. A good therapist should have resolved old patterns, but no one is completely immune. This is where a second opinion with an experienced therapist can help clarify what is going on and how to help you get unstuck.

I recently had a consultation with a patient and therapist who cared a lot for one another. The therapist had helped a great deal, but the more she did, the more the patient experienced needs for the therapist to do even more. When the therapist started to burn out, they came to a crisis. The key was realizing that both were having trouble dealing with old anger. The patient had a history of neglect, but as long as the therapist would do extra things for her, she didn’t feel neglected and didn’t have to face her anger. The therapist, without realizing it, was instinctively afraid of the anger, too. Extra gestures that seemed soothing and helpful were really keeping them both from facing the powerful rage that was the patient’s healthy and natural reaction to her early neglect. As they understood what was happening, they began to process the anger and the therapy was on the move again.

There are other times when there may be real questions about whether the therapy is the right one for the problem. Nowadays this can be tricky because there are so many therapies. Therapists can get caught up in arguments that sound more like religion, making it hard to be objective about pros and cons of different approaches. My opinion is that all therapies boil down to a very few pathways that lead to moments of change. From that point of view the differences are not so black and white, and depend a lot on individual style and preference. Once again, a second opinion can help you look more objectively at what changes you want to make and whether the therapy you are in is going to help you do the work you need to do.

Then there are situations where something is truly amiss and you question whether you are getting good therapy. Is it you or is it the therapist? The worst is when you are invested in the therapy and attached to the therapist but you think there is something wrong with the way the therapy is going. A second opinion can help you evaluate the situation and decide whether it can be set right or if you should make the difficult decision to leave.

In each situation, a very experienced, properly licensed and credentialed therapist can help you understand and make an educated judgment about what to do.

In the meantime, I’ll suggest two resources. The first is, (see Links) a site with excellent guidance about how therapy should be conducted. The second resource is on this site, the Scarsdale Psychotherapy Self-Test. This test is designed to help you think about your therapy in a way that will help you evaluate for yourself if you are getting the best psychotherapy experience you can have.


  • When you try to help a stuck patient and therapist do you see both of them or just one of them? If you see just one of them how does the other one know what you said? I guess what I’m asking for is a more nuts and bolts description, of what a third-party does a d how it works to help a committed therapeutic relationship?

    • Thanks for the question. You are quite right that including both therapist and patient is key. The work starts with a phone conversation with either one, then making a plan. I am quite flexible about setting up contacts, depending on what the phone call brings to light. Face to face with the patient is, I think, the most critical. Talking on the phone with the therapist can be OK. A joint meeting can be very enlightening and helpful in re-cementing a tattered relationship. I try to be very supportive with everyone, because you are all trying hard to make the therapy work. I don’t think therapy should be mysterious, and if you agree you are stuck, there should be an identifiable reason. Once clarified, it should be possible to develop a plan for working out the problem.

      If you think in terms of mindfulness, the process of looking at the therapy from outside is a good way to find a calming perspective on what you are experiencing and what your therapist is experiencing.


Leave a Comment